Progress in modeling dynamic systems for sustainable development.

This Perspective evaluates recent progress in modeling nature-society systems to inform sustainable development. We argue that recent work has begun to address longstanding and often-cited challenges in bringing modeling to bear on problems of sustainable development. For each of four stages of modeling practice-defining purpose, selecting components, analyzing interactions, and assessing interventions-we highlight examples of dynamical modeling methods and advances in their application that have improved understanding and begun to inform action. Because many of these methods and associated advances have focused on particular sectors and places, their potential to inform key open questions in the field of sustainability science is often underappreciated. We discuss how application of such methods helps researchers interested in harnessing insights into specific sectors and locations to address human well-being, focus on sustainability-relevant timescales, and attend to power differentials among actors. In parallel, application of these modeling methods is helping to advance theory of nature-society systems by enhancing the uptake and utility of frameworks, clarifying key concepts through more rigorous definitions, and informing development of archetypes that can assist hypothesis development and testing. We conclude by suggesting ways to further leverage emerging modeling methods in the context of sustainability science.

A cognitive behavioural model of the bidirectional relationship between disordered eating and diabetes self care in adult men with Type 1 diabetes mellitus.

AIMS: This qualitative study aimed to develop the first cognitive behavioural (CBT) model outlining the development and maintenance of disordered eating in adult men living with Type 1 diabetes to improve on previous theoretical models of Type 1 diabetes and disordered eating and to draw comparisons to women with Type 1 diabetes and disordered eating. METHODS: Twenty-seven men (n = 16 with Type 1 diabetes and disordered eating, n = 11 with Type 1 diabetes without disordered eating) participated in semi-structured interviews. Data were analysed using thematic analysis and individual CBT formulations were developed for each participant to inform the model. RESULTS: Men with Type 1 diabetes and disordered eating experience negative thoughts about food, insulin, weight/shape and diabetes itself, which cause negative emotions such as fear and vulnerability and difficulties with diabetes self care such as problems with hyper and hypoglycaemia and problems accessing structured education and technology result in men feeling more dissatisfied about their body weight/shape. CONCLUSIONS: This CBT model of disordered eating in men with Type 1 diabetes can guide new interventions.

Communication strategies for nursing research with older adults diagnosed with schizophrenia using life course theory.

PURPOSE: To explore effective communication strategies that may be used to promote efficacious research with older adults diagnosed with schizophrenia. DESIGN: A theoretical framework of Life Course Theory was used to examine the problems of communicating in research settings with older adults diagnosed with schizophrenia and present potential effective solutions to these problems. METHODS: Using Life Course Theory as an underpinning, a literature review was conducted regarding communication strategies/methods commonly used in psychiatric nursing. This paper deductively presents how these strategies/methods could theoretically improve nursing research with older adults diagnosed with schizophrenia. RESULTS: Four main potential effective strategies for communication with older adults diagnosed with schizophrenia in nursing research were identified which were (1) giving space; (2) shortened intervals; (3) the use of simple, meaningful phrases; and (4) showing engagement. CONCLUSIONS: Older adults diagnosed with schizophrenia may be given more opportunities to share their input regarding their perceptions and valuable input regarding health care systems if these effective strategies of communication are used when conducting nursing research. CLINICAL RELEVANCE: There is a need to gain more information regarding the perceptions of older adults diagnosed with schizophrenia as they are living longer and are entering into a health care system that is often at a quandary as to how to best care for them. The strategies delineated in this paper are part of an ongoing project to co-develop a model with older adults diagnosed with schizophrenia specifically tailored to improve their health outcomes and quality of life.

Developing Algorithm Based on Activity and Mobility for Pressure Ulcer Risk Among Older Adult Residents: Implications for Evidence-Based Practice.

BACKGROUND: A pressure ulcer (PU) is a localized injury to the skin or underlying tissue usually over a bony prominence. The prevention PU per patient per day is costly; therefore, the detection of a PU at its earliest stage is imperative to afford timely interventions. Currently, there are very few clinically useful tools to assist with early PU detection and prevention. AIM: There were two primary aims of this study: (1) to investigate the relationship between activity, mobility, and PU development; and (2) to ascertain the next steps for delineating an algorithm based on activity and mobility for detecting PU risk among older adult residents in long-term care. METHOD: This quantitative, prospective, descriptive, non-experimental study was conducted between July 2019 and March 2020 among 53 older adult residents who were followed for 4 consecutive days. Participants' Braden score, Elderly Mobility Scale (EMS) score, Movement Level, and 6-item Cognitive Impairment Test score were assessed. Further, the sacrum and heels were assessed daily using a non-invasive subepidermal moisture (SEM) scanner and visual skin assessment (VSA). SEM values > 0.5 were considered as indicative of the presence of an SEM-PU. RESULTS: The incidence rate of VSA-PU was 15.1% (N = 8). There was an incidence of 87.5% (N = 42) of SEM-PU damage. According to the Braden subscale, Mobility Braden, most of the participants (62.2%, N = 33) were assessed as having no limitations/slightly limited mobility, while the EMS indicated that most of the participants (67.9%, N = 36) were classed in an independent category. From the 42 SEM-PUs observed, 62% (N = 26) occurred among the low movers, and 38% (N = 16) occurred among the high movers. LINKING EVIDENCE TO ACTION: Using traditional methods for the assessment of movement does not provide insight into the protective nature of the movement. Given that both low- and high-moving patients can develop tissue damage, it is important to focus on the assessment of movement using more objective measures and algorithms, which enable real-time assessment of the protective nature of the movement. This would enable development of person-centered PU prevention strategies to reduce the burden of this significant healthcare problem.

External Facilitation as an Evidence-Based Practice Implementation Strategy During an Antibiotic Stewardship Collaborative in Neonatal Intensive Care Units.

BACKGROUND: Despite research support, evidence-based practices (EBPs) are inconsistently implemented throughout the United States. Facilitation is one implementation strategy to speed adoption in clinical settings. Facilitation has not been previously described in the literature as an implementation strategy within neonatal care. PURPOSE: The purpose of this study was to categorize and describe essential features of facilitation in the context of implementing an EBP using perspectives elicited from neonatal clinicians and external facilitators (EFs). METHODS: In this qualitative descriptive study, semistructured interviews were conducted with a purposive sample of neonatal clinicians and EFs. Participants shared their experiences related to the strategy of facilitation while implementing an EBP during the California Perinatal Quality Care Antibiotic Stewardship Collaborative. Interviews were transcribed, coded, and analyzed using directed content analysis. RESULTS: Five categories emerged to address facilitation as an implementation strategy: (a) facilitated change management, (b) unit and organization receptivity, (c) evaluation strategies, (d) supportive culture, and (e) facilitator stewardship. LINKING EVIDENCE TO ACTION: Implementing EBP is complex and multifactorial. Results from this study provide insights into influencing barriers and drivers as experienced by internal and external facilitators, and context factors that impacted the success of implementation.

Concept Analysis and the Advance of Nursing Knowledge: State of the Science.

PURPOSE: Despite an overwhelming increase in the number of concept analyses published since the early 1970s, there are significant limitations to the impact of this work in promoting progress in nursing science. DESIGN: We conducted an extensive review of concept analyses published between 1972 and 2017 to identify patterns in analysis and followed this with exploration of an exemplar related to the concept of normalization to demonstrate the capabilities of analysis for promoting concept development and progress. METHODS: Scoping review of peer-reviewed literature published in the Cumulative Index to Nursing and Allied Health Literature (CINAHL) in which the terms "concept analysis," "concept clarification," and "concept derivation" appeared in any part of the reference. The original search returned 3,489 articles. This initial pool was refined to a final sample of 958 articles published in 223 journals and addressing 604 concepts. A review of citations of the original analysis of the concept of normalization resulted in 75 articles selected for closer examination of the process of concept development. FINDINGS: Review showed a clear pattern of repetition of analysis of the same concept, growth in number of published analyses, preponderance of first authors with master's degrees, and 43 distinct descriptions of methods. Review of the 75 citations to the normalization analysis identified multiple ways concept analysis can inform subsequent research and theory development. CONCLUSIONS: Conceptual work needs to move beyond the level of "concept analysis" involving clear linkage to the resolution of problems in the discipline. Conceptual work is an important component of progress in the knowledge base of a discipline, and more effective use of concept development activities are needed to maximize the potential of this important work. It is important to the discipline that we facilitate progress in nursing science on a theoretical and conceptual level as a part of cohesive and systematic development of the discipline. CLINICAL RELEVANCE: The absence of effective concepts impedes the ability to recognize, discuss, define, and conduct studies important to clinical practice and research. This article reflects the pressing need as well as the potential for concept analysis work to be approached in a way that promotes nursing science and enables conceptually sound research to improve clinical care.

Impact of Managers' Coaching Conversations on Staff Knowledge Use and Performance in Long-Term Care Settings.

BACKGROUND: Extended lifespans and complex resident care needs have amplified resource demands on nursing homes. Nurse managers play an important role in staff job satisfaction, research use, and resident outcomes. Coaching skills, developed through leadership skill-building, have been shown to be of value in nursing. AIMS: To test a theoretical model of nursing home staff perceptions of their work context, their managers' use of coaching conversations, and their use of instrumental, conceptual and persuasive research. METHODS: Using a two-group crossover design, 33 managers employed in seven Canadian nursing homes were invited to attend a 2-day coaching development workshop. Survey data were collected from managers and staff at three time points; we analyzed staff data (n = 333), collected after managers had completed the workshop. We used structural equation modeling to test our theoretical model of contextual characteristics as causal variables, managers' characteristics, and coaching behaviors as mediating variables and staff use of research, job satisfaction, and burnout as outcome variables. RESULTS: The theoretical model fit the data well (χ2 = 58, df = 43, p = .06) indicating no significant differences between data and model-implied matrices. Resonant leadership (a relational approach to influencing change) had the strongest significant relationship with manager support, which in turn influenced frequency of coaching conversations. Coaching conversations had a positive, non-significant relationship with staff persuasive use of research, which in turn significantly increased instrumental research use. Importantly, coaching conversations were significantly, negatively related to job satisfaction. LINKING EVIDENCE TO ACTION: Our findings add to growing research exploring the role of context and leadership in influencing job satisfaction and use of research by healthcare practitioners. One-on-one coaching conversations may be difficult for staff not used to participating in such conversations. Resonant leadership, as expected, has a significant impact on manager support and job satisfaction among nursing home staff.

The Theory of Planned Behavior and Physical Activity Change: Outcomes of the Aging Well and Healthily Intervention Program for Older Adults.

The predictive value of the Theory of Planned Behavior (TPB) on intention and physical activity (PA) over time was examined. Data from the Aging Well and Healthily intervention program (targeting perceived behavioral control and attitude, not subjective norm) were analyzed, including pretest (T0), posttest (T1, except subjective norm) and 4-6 months follow-up (T2, PA outcomes only) (N = 387, M age 72 years). Structural equation modeling was used to test a TPB model. PA was measured subjectively using the Voorrips sports subscale (T0 and T2), items measured perceived increase in PA (T1), and adherence to exercises (T1 and T2). Model fit was good. The TPB explained variation in intention well (R2 .54-.60) and some PA behavior (R2 .13-.16). The intervention successfully got participants to exercise independent of the measured TPB concepts. More TPB studies in the context of interventions are needed.

Explaining Adolescent Drug Use in Adjacent Generations: Testing the Generality of Theoretical Explanations.

We tested the assumption that theories of drug use are able to account for behavior across varying contexts and populations by examining whether control, learning, and elaborated theories provide similar explanations for adolescent drug use in adjacent generations. We used data from the Rochester Youth Development Study and Rochester Intergenerational Study which followed a sample of adolescents starting at age 14 and their oldest biological child. Cross-generational analysis between theoretical variables measured at age 14 and drug use measured at approximately ages 15 and 16 were used. Regression models testing for each theoretical framework found that in general, they appear to operate similarly in adjacent generations. We conducted 14 tests of equality for pairs of coefficients across the generations; no statistically significant differences are observed. Overall, these theories offer general explanations for adolescent drug use with respect to risk and protective factors for parents and their children. Theoretical and policy implications are discussed.

"Exploratory experimentation" as a probe into the relation between historiography and philosophy of science.

This essay utilizes the concept "exploratory experimentation" as a probe into the relation between historiography and philosophy of science. The essay traces the emergence of the historiographical concept "exploratory experimentation" in the late 1990s. The reconstruction of the early discussions about exploratory experimentation shows that the introduction of the concept had unintended consequences: Initially designed to debunk philosophical ideas about theory testing, the concept "exploratory experimentation" quickly exposed the poverty of our conceptual tools for the analysis of experimental practice. Looking back at a number of detailed analyses of experimental research, we can now appreciate that the concept of exploratory experimentation is too vague and too elusive to fill the desideratum whose existence it revealed.

The current status of theory evaluation in nursing.

AIMS: To identify the current status of theory evaluation in nursing and provide directions for theory evaluation for future development of theoretical bases of nursing discipline. BACKGROUND: Theory evaluation is an essential component in development of nursing knowledge, which is a critical element in development of nursing discipline. Despite earlier significant efforts for theory evaluation in nursing, a recent decline in the number of theory evaluation articles was noted and there have been few updates on theory evaluation in nursing. DESIGN: Discussion paper. DATA SOURCES: A total of 58 articles published from 2003-2014 were retrieved through searches using the PUBMED, PsyInfo and CINAHL. The articles were sorted by the area of evaluation and analysed to identify themes reflecting the theory evaluation process. IMPLICATIONS FOR NURSING: Diverse ways of theory evaluation need to be continuously used in future theory evaluation efforts. CONCLUSION: Six themes reflecting the theory evaluation process were identified: (a) rarely using existing theory evaluation criteria; (b) evaluating specifics; (c) using various statistical analysis methods; (d) developing instruments; (e) adopting in practice and education; and (f) evaluating mainly middle-range theories and situation-specific theories.

Strengthening Theoretical Testing in Criminology Using Agent-based Modeling.

OBJECTIVES: The Journal of Research in Crime and Delinquency (JRCD) has published important contributions to both criminological theory and associated empirical tests. In this article, we consider some of the challenges associated with traditional approaches to social science research, and discuss a complementary approach that is gaining popularity-agent-based computational modeling-that may offer new opportunities to strengthen theories of crime and develop insights into phenomena of interest. METHOD: Two literature reviews are completed. The aim of the first is to identify those articles published in JRCD that have been the most influential and to classify the theoretical perspectives taken. The second is intended to identify those studies that have used an agent-based model (ABM) to examine criminological theories and to identify which theories have been explored. RESULTS: Ecological theories of crime pattern formation have received the most attention from researchers using ABMs, but many other criminological theories are amenable to testing using such methods. CONCLUSION: Traditional methods of theory development and testing suffer from a number of potential issues that a more systematic use of ABMs-not without its own issues-may help to overcome. ABMs should become another method in the criminologists toolbox to aid theory testing and falsification.

Pediatric Nurses' Experiences With Professional Boundaries and Ethical Challenges: A Secondary Analysis.

Pediatric nursing is known to be challenging in relation to balancing care and relationships with children and families. There is a growing body of knowledge about the perspectives of the various aspects of care; nurses' thoughts and perspectives, parents' needs and desire for collaboration, and the continued care and support required are related. This article is a secondary analysis of data collected using the theoretical framework and methodology of Margaret Newman's Health as Expanding Consciousness to understand how pediatric nurses develop knowledge. Interviews were conducted with eight pediatric nurses working in inpatient settings with children and families experiencing chronic, complex healthcare needs. The nurses, whose experience spanned between 3 and 30 years, related to stories of how their view of practice evolved over time and with experiences and the challenges to professional boundaries and ethical practice. Reflection on these experiences brought nurses to acknowledge sometimes crossing professional boundaries and struggling with ethical issues. Ultimately, reflections brought appreciation of lessons learned and evolution of the understanding of their role in the care of these children and families.

Daily social comparisons among women in midlife with elevated risk for cardiovascular disease: A within-person test of the identification/contrast model.

Women age 40-60 are disproportionately affected by health problems that increase their risk for cardiovascular disease (CVD; e.g. hypertension). Social comparisons (i.e. self-evaluations relative to others) are known to influence health in this and other groups, but their nature and consequences in daily life are poorly understood. We conducted an ecological momentary assessment study over 10 days (5x/day) with 75 women ages 40-60 who had ≥1 CVD risk conditions (MAge = 51.6 years, MBMI = 34.0 kg/m2). Using a mix of frequentist and Bayesian analytic approaches, we examined characteristics of women's naturally occurring comparisons and tested predictions from the Identification/Contrast Model within-person (e.g. identifying with an upward target results in positive affect, whereas contrasting results in negative affect). Comparisons occurred at 21% of moments, with considerable within-person variability in response. In line with predictions from the Identification/Contrast Model, women were more likely to experience positive affect after upward identification or downward contrast and more likely to experience negative affect after upward contrast or downward identification, though observed nuances warrant additional consideration. Overall, findings support the Identification/Contrast Model to describe women's comparison experiences as they occur in daily life. Future work should determine pathways between the immediate consequences of comparisons and longer-term health outcomes.

Measurement Invariance Testing Works.

Psychometricians have argued that measurement invariance (MI) testing is needed to know if the same psychological constructs are measured in different groups. Data from five experiments allowed that position to be tested. In the first, participants answered questionnaires on belief in free will and either the meaning of life or the meaning of a nonsense concept called "gavagai." Since the meaning of life and the meaning of gavagai conceptually differ, MI should have been violated when groups were treated like their measurements were identical. MI was severely violated, indicating the questionnaires were interpreted differently. In the second and third experiments, participants were randomized to watch treatment videos explaining figural matrices rules or task-irrelevant control videos. Participants then took intelligence and figural matrices tests. The intervention worked and the experimental group had an additional influence on figural matrix performance in the form of knowing matrix rules, so their performance on the matrices tests violated MI and was anomalously high for their intelligence levels. In both experiments, MI was severely violated. In the fourth and fifth experiments, individuals were exposed to growth mindset interventions that a twin study revealed changed the amount of genetic variance in the target mindset measure without affecting other variables. When comparing treatment and control groups, MI was attainable before but not after treatment. Moreover, the control group showed longitudinal invariance, but the same was untrue for the treatment group. MI testing is likely able to show if the same things are measured in different groups.

Factors Influencing Nurses' Intentions to Protect Patient Privacy: A Survey-Based Study Using the Theory of Planned Behavior.

Background and Purpose: Patient privacy and confidentiality are fundamental ethical principles in healthcare. Protecting patient privacy, which is accepted as a patient's right, is one of the responsibilities of nurses. Few studies on patient privacy among nurses have used social cognitive approaches. The purpose of this study is to examine nurses' intentions to protect patient privacy using the theory of planned behavior (TPB). Methods: This is a cross-sectional and correlational design study. The study sample consisted of 202 nurses working in the emergency departments, operating rooms, inpatient wards, and intensive care units of the hospitals. Research data were collected using a face-to-face questionnaire that included TPB components on patient privacy. The proposed research model was tested using structural equation modeling. Results: Attitude (ß = .238, p < .05), subjective norm (ß = .295, p < .05), and moral norm (ß = .337, p < .05) toward patient privacy are positive predictors of intention. The moral norm is the most effective component of intention. Perceived behavioral control is not a significant predictor of intention (ß = .049, p > .05). Implications for Practice: Norms that create a sense of moral obligation in nurses are a significant determinant in increasing the intention to protect patient privacy. Interventions that improve moral norms, attitudes, and subjective norms will increase the intention to protect privacy. Nurse managers should provide nurses with adequate skills, resources, and an appropriate work environment to ensure perceived behavioral control regarding patient privacy.

Structural equation model testing the situation-specific theory of heart failure self-care.

AIM: To test the situation-specific theory of heart failure self-care with structural equation modelling. BACKGROUND: Several authors have proposed theories on heart failure self-care, but only the situation-specific theory of heart failure self-care by Riegel and Dickson is focused on the process that patients use to perform self-care. This theory has never been tested with structural equation modelling. DESIGN: A secondary analysis of data from a cross-sectional study. METHODS: Patients with heart failure were recruited in 21 cardiovascular centres across Italy during 2011. Data were collected with a sociodemographic questionnaire, chart abstraction for clinical data and the Self-Care of Heart Failure Index v.6.2. RESULTS: A sample of 417 participants was enrolled in the study (59% males, mean age 72 years). The following propositions were tested and supported: Symptom monitoring correlates with treatment adherence; symptom monitoring and treatment adherence have a direct, positive relationship with symptom recognition and evaluation that in turn have a direct, positive relationship with treatment implementation; treatment implementation has a direct, positive relationship with treatment evaluation. In addition, the following three relationships were found: Symptom monitoring has a direct, positive relationship with treatment implementation; symptom recognition and evaluation have direct, positive relationships with treatment evaluation and symptom monitoring correlates with treatment evaluation. [Correction added on 9th April 2013, after first online publication: '…symptom monitoring correlates with treatment implementation.' has been corrected to read '…symptom monitoring correlates with treatment evaluation.'] CONCLUSION: The data support the situation-specific theory of heart failure self-care with the addition of three new relationships that emerged from the analysis. Results of this study lend further support to the use of the situation-specific theory of heart failure self-care in research and practice.

Testing the informal care model: intrapersonal change in care provision intensity during the first lockdown of the COVID-19 pandemic.

Informal care, meaning taking health-related care of people in their own social network, is a topic that gets more and more attention in social science research because the pressure on people to provide informal care is rising due to ageing societies and policy changes. The Informal Care Model developed by Broese van Groenou and de Boer (Eur J Ageing 13(3):271-279, 2016) provides a theoretical foundation to understand under what conditions a person provides informal care. We test this theoretical model by applying it to intrapersonal changes in informal care provision during the first COVID-19 lockdown in the Netherlands in Spring 2020. Data from the LISS panel from two time points, March 2020 and data from July over the period of April/May 2020, were analysed with multinominal multilevel regression analysis (N = 1270 care situations of 1014 caregivers). Our results showed that the individual determinants (Do I have to?, Do I want to?, and especially Can I?) discussed in the Informal Care Model (apart from a series of control variables) are contributing substantially to the understanding of intrapersonal changes in care provision during the first lockdown and by that, we found empirical support for the theoretical model. We conclude that on top of its original purpose to explain between-individual differences in informal caregiving using static indicators, the Informal Care Model is also useful to explain intrapersonal changes in informal caregiving using dynamic indicators.

A longitudinal study of the stress-buffering effect of social support on postpartum depression: a structural equation modeling approach.

PURPOSE: Postpartum depression (PPD) impacts about one out of eight new mothers. Research has demonstrated that social support is a protector of PPD. Nevertheless, there has been disagreement on how social support influences depression. The objective is to test two theories - main-effect theory and stress-buffering theory of social support on PPD with different definitions of stress and two types of social support. METHODS: Secondary longitudinal data from the National Data Archive on Child Abuse and Neglect were used. Parenting stress and difficult life circumstances (DLC) measured at six-month postpartum was used to predict the changes in depression from six- to 12-month postpartum; social support at six-month postpartum was conceptualized as a moderator between stress and PPD. Structural Equation Modeling was adopted for the longitudinal analyses. RESULTS: DLC and parental distress both showed long-lasting impacts on PPD. Social support was not found to have a direct or indirect effect on PPD. Neither the stress-buffering theory nor the main-effect model was endorsed by this study. CONCLUSION: Interventions that are accessible to new mothers and aim to improve self-efficacy are recommended. Measures with higher psychometric quality should be used in moderation research. More longitudinal studies with shorter lags between measurement occasions are warranted.